Arthroscopic Fixation of a Posterior Cruciate Ligament Avulsion Fracture: A Case Report
Keywords:
Posterior Cruciate Ligament, PCL Avulsion Fracture, Arthroscopic Fixation, Adolescent, Case ReportAbstract
Introduction: Avulsion fractures of the posterior cruciate ligament (PCL) are relatively uncommon injuries, particularly in the adolescent population. These injuries involve detachment of the ligament from its tibial insertion and may result in persistent posterior knee instability if not properly managed. Accurate diagnosis and appropriate fixation are essential to restore normal knee kinematics and prevent long-term complications.
Case Illustration: This report presents the case of a 16-year-old female patient with a 3-month history of left knee pain and instability following a fall during training. Clinical examination revealed positive posterior drawer and valgus stress tests. Magnetic Resonance Imaging (MRI) confirmed a displaced tibial avulsion fracture of the PCL (Meyers-McKeever Type III) and a concomitant full-thickness MCL tear. The patient underwent a single-stage procedure: arthroscopic suspensory button fixation for the PCL avulsion and an anatomic reconstruction of the MCL.
Discussion: Surgical management is superior to non-operative treatment for displaced PCL avulsions, citing improved union rates and better objective stability (Gopinatth et al., 2023). The rationale for selecting an arthroscopic suspensory fixation technique (Kan et al., 2020) over traditional open or arthroscopic suture methods is discussed, highlighting its minimally invasive nature, robust fixation, and avoidance of complications associated with other techniques (Hu et al., 2025).
Conclusion: Arthroscopic suspensory fixation represents an effective and reliable treatment option for displaced PCL tibial avulsion fractures in adolescents. This technique enables stable fixation, supports early rehabilitation, and contributes to satisfactory restoration of knee stability, even in chronic cases.
References
Gopinatth, V., Mameri, E.S., Casanova, F.J., Khan, Z.A., Jackson, G.R., McCormick, J.R., Brophy, R.H., Knapik, D.M., LaPrade, R.F. and Chahla, J. (2023) Systematic Review and Meta-analysis of Clinical Outcomes After Management of Posterior Cruciate Ligament Tibial Avulsion Fractures. Orthopaedic Journal of Sports Medicine, 11(9).
Guimarães, T.M., Helito, C.P., Angelini, F.J., Demange, M.K., Pécora, J.R. and Helito, C.P. (2017) Delayed treatment of a posterior cruciate ligament tibial insertion avulsion fracture in a child with open physis: a case report with a 4-year follow-up. Journal of Pediatric Orthopaedics B, 26(5), pp.477–481.
Gwinner, C., Kopf, S., Hoburg, A., Haas, N.P. and Jung, T.M. (2014) Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament using the tightrope fixation device. Arthroscopy Techniques, 3(3), pp.e377-e382.
Hu, Z., Xia, Y., She, C., Li, L. and Xu, W. (2025) Clinical outcomes of four different surgical techniques for posterior cruciate ligament tibial avulsion fractures: a comparative study. BMC Musculoskeletal Disorders, 26(1), p.512.
Kan, H., Nakagawa, S., Hino, M., Komaki, S., Arai, Y., Inoue, H. and Takahashi, K. (2020) Arthroscopic Fixation Technique for Avulsion Fracture of the Posterior Cruciate Ligament From the Tibia. Arthroscopy Techniques, 9(11), pp.e1819-e1824.
Kim, M.S., Lee, Y.I. and Kim, I.J. (2019) Superficial and Deep Medial Collateral Ligament Reconstruction for Chronic Medial Instability of the Knee. Clinical Orthopaedics and Related Research, 477(3), pp. 585-592.
Kim, S-J., Jo, S-B., Kim, S-G., Park, I-S., Kim, H-P. and Kim, S-H. (2010) Peel-off injury at the tibial attachment of the posterior cruciate ligament in children. The American Journal of Sports Medicine, 38(9), pp.1900–1906.
Meyers, M.H. and McKeever, F.M. (1959) Fracture of the intercondylar eminence of the tibia. The Journal of Bone and Joint Surgery. American volume, 41-A(2), pp.209-222.
Nassar, J.E., Sleem, B., Tollefson, L.V. and LaPrade, R.F. (2025) Management and reconstruction strategies for multiligament knee injuries: Advances in diagnosis, surgical techniques, and rehabilitation. Journal of Arthroscopic Surgery and Sports Medicine.
Romeyn, R.L., Jennings, J. and Davies, G.J. (2008) Rehabilitation of combined complex ligament injuries. North American Journal of Sports Physical Therapy, 3(4), pp.214-222.
Ross, A.C. and Chesterman, P.J. (1986) Isolated avulsion of the tibial attachment of the posterior cruciate ligament in childhood. The Journal of Bone and Joint Surgery. British volume, 68(5), p.747.
Sleem, B., Nassar, J.E., Tollefson, L.V. and LaPrade, R.F. (2025) Management and reconstruction strategies for multiligament knee injuries: Advances in diagnosis, surgical techniques, and rehabilitation. Journal of Arthroscopic Surgery and Sports Medicine..
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